Prognostic value of hyponatremia during ACUTE PAINFUL EPISODES in sickle cell disease.
Am J Med. 2020 Mar 18;:
Authors: Rech JS, Yao K, Bachmeyer C, Bailleul S, Javier O, Grateau G, Lionnet F, Steichen O
BACKGROUND: Low plasma sodium concentration has been recognized as a prognostic factor in several disorders but never evaluated in sickle cell disease. The present study evaluates its value at admission to predict a complication in adult sickle cell disease patients hospitalized for an initially uncomplicated acute painful episode.
METHODS: The primary endpoint of this retrospective study, performed between 2010 and 2015 in a French referral center for sickle cell disease, was a composite criterion including acute chest syndrome, intensive care unit transfer, red blood cell transfusion or inpatient death. Analyses were adjusted for age, sex, hemoglobin genotype and concentration, LDH concentration, and white blood cell count.
RESULTS: We included 1218 stays (406 patients). No inpatient death occurred during the study period. Hyponatremia (plasma sodium ≤ 135 mmol/L) at admission in the center was associated with the primary endpoint (adjusted odds ratio (OR) 1.95 [95% confidence interval (CI) 1.3-2.91, p=0,001]), and with acute chest syndrome (OR 1.95 [95% CI 1.2-3.17, p=0.008]) and red blood cell transfusion (OR 2.71 [95% CI 1.58-4.65, p<0.001]), but not significantly with intensive care unit transfer (OR 1.83 [95% CI 0.94-3.79, p=0.074]). Adjusted mean length of stay was longer by 1.1 days (95% CI 0.5-1.6, p<0.001) in patients with hyponatremia at admission.
CONCLUSIONS: Hyponatremia at admission in the medical department for an acute painful episode is a strong and independent prognostic factor of unfavorable outcome, and notably acute chest syndrome. It could help targeting patients who may benefit from closer monitoring.
PMID: 32199810 [PubMed - as supplied by publisher]